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APPROVALS DATE ID/SIG COMMENTS OWNDR BUILDER DELCAII TION <br />I hd.b, affm uodcr ,.nalry of prjury rhar I d cxonpl from rh. conh.tou Lic.n* Lrw for fi. lollo*in8 ra$n (S( 703 I 5 <br />Busines and ProfNion Codc): Any City or Cormy whicn icqutB a !.rnit lo consl ct, altq. impmve donolish or ErEir dy <br />strucruc rior ro irs isu ce abo r€quiE rhc aplicanr lor sucfi pdnil to fiL a siBocd srar@or thar h. o. shc 6 lic .d pui$at <br />b rn€ provisioN otdE Conrrlcrois L&nlcd L.v (Chrpt6 9, Commci.s with S4lioo 7000 ofDivis'oo I ofth. Busids .nd <br />PofNio6 cod.) or thar hc o, shc ts qnpt $dcfton dd $c b€sis lor rhe allclcd d@ptio. A.y iohrion of sdion ?011.5 byany <br />lpplicant for ap6 lsubjetslh. applicanllo.civilp.nsllyofnot morclhe liv. hund!€d dollds {t5C\)). <br />Xi2lll. I .",o.rrhe rcp.flr. or my cmployG wirh *aa6 6 rh.i, $1. codpoerion, $ill do tlE $ort md rnc hc1rc b mr''intsldai or ord..l for el. (sa 704,1, Bds6e ed PrcfGsios Cod.: Ttc (oiiru.1oas Lic6F tns do6 nol apply lo e ownd ol <br />rh€ FoFry who builds or idFo6lrE&n, &d who do6 sucn \od hinsclr or h*ll or fiiough his or hr oM .mploys. <br />Drovided thar such impmvffirs 5. mr inta&dorofir.d aorsk.I[ hosd6, rlE buildin3 or impm!.Mr is $ld wilhi. on yur <br />of@nplc1iotr th. O*r{ Buildr will halc $c hrdo olrtroins rhar hc or shc dt nor bnild or imptuv. Lnc FtrFly aor lh. po,rDp of <br />_1, a o*nd ofrh. ropdly, d .(losiv.ly conbadina w h licsdt co.ta.lloE to .oishd rh€ Eojtrt (S{ ?044, B6ir6 <br />and ltoasbn Cod. 'I fie Conl,acror's Liccnse Lav do5 nor apply lo 4 osns ol prop.rl y Nho build! or impov* rhdsn, <br />a,rd wno conh(s lor su.h projcls wirh a Cofudo(n licmdl A'6Mr to thcConrradois Li.dsc La$). <br />ronc\crDd und.r sAri^n .ts AP('Lfll.Er.a"n I t <br />1** tltl ri ,,*.". tul(^.--,lv-tbr \!0aKE&51(!IISENSAIjON <br />I hstby art;rr unds ,r.alry o.pop.y nn" or,r," rorro*.jffiU <br />I har e Md will Minrain a C.nificale of CoMl ro Self- lmule for Norkgr conD.nsaron, s povid.d ror by Sdio. I700 ofrh. <br />Labor codc, lor lh. psfol:Mc. of tn€ \vorh for <br />"'nich <br />rhc pdni' b iaso.d <br />-l <br />har e and vrll maintain $ukec' corpdsalnJn iGurance. 6 requncd hlSerionlT(r0ofrhc tjbor ( odc. aor lh€ Flomance of <br />lhe wo.k lor yhich lhls pmil is is$d. My eorlsi conrr€Nlioo iNur c. ceitr od Fli.y n!6bd e.l <br />(I9 .-n, ,n, *,n. *^nnan(. orrh. sorl rur \h,ch rhis Dmn is issued.I sh,ll nor dbploy.ny pc,son in my murs <br />'e 6robd{n. lubj{r rorh.M 6'c.mp.Mrion hwsoa(dliaomi,. md aSrerhar ill should bcconc subjd torhc <br />worl6 compftario.povisioN oas.ction.l?00 ofrh.llbo. ('odq I sn ll. fonhvilh co'nply vilh lhoFprcvisiod.. <br />WA|INING: Iailur. to sur€ wort6' €onp.reslion corsas€ is unlawtul. ud sh.ll subjdl d dnplord ro dtriMl Flahis md <br />civil fines up ro on€ hundEl lhousmd dolla {3100.000). in addilion ro lhc cosr ofconpc6atio.. ddna86 a prolidcd-for rhc <br />(*"'tz + <br />t)r (1. \ll \ r ()\ <br />l-icensc Clas:-l.icense Numb.' <br />D.lc Con(rr.(o.: <br />CAISIBUCIIANIINDIIC.A(iE!(I <br />I hcEby amrfl und6 pcrahy ofpcrjurythat rhscis a coNrucriotr ldditrE alcncy for lhe pqfomdrc ofth.*o for which lhis p6mn is <br />isslcd {Sr.109?, Civ. C.) <br />AIIITCANLDICIJAAITqI <br />I hElty arm undd p6ahy oi psjury on. of thc folloqing d*ldotiom: <br />D.molilion P@irs&b.to! Norificalion F.d-61 R.grlariorc Gnb 40, P.n6) <br />-R.qxt <br />dt lrdof Ndificdbn <br />-l <br />cdiry tul lhe lcddal Esulalioa rcgddi.s abdos rdoval d. iol +pliobL to ots Proj61 <br />f.Eb .criry rr'a r r'a.c eO rr'i! arpl@rion &d nd. rhd dr rbo!. infondion i5 conqr I asrc ro conpry snh a ciryddco@ryr odnlanc6 and Sr . LzB dd uE ro bu ildins coGllucr io., dd ho.by a!fio.ia rcpr.stadv6 oa$i! Ciry od Couoly lo dt6 upon th. <br />abovc Enlioned prop€n' lor insp<rion puDos6 <br />ppli.Nnt or Ag.nl Signrrurr <br />Pemilen,'n. (prn'l):PtlXl\4*A ^"-ul/'1 <br />Site-Work <br />Underground <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life S afety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rouoh) <br />Rough <br />Service Meter rl <br />FINAL \\\\\\v <br />^1/'44)Notes, Remarks, Etc. <br />) <br />( <br />ELECTRICAL-INSPECTOR RECORD <br />Pole Bases <br />Meter Release I hqeby allirm undq p€oalty of p.rju.y lhal I m lic.nsd lnds pro!6ion olCh3pl6I (com,n .ci.s *nh Setion 7000) ofDivision 3 <br />ol lhc SusinN ed Pmfsio6 Codc. dmylicN is in tull forcc dd.,Ial <br />L.nd.ai Add's <br />- <br />= <br />= <br />I <br />I <br />I